Cognitive and motor impairments are the two most common causes of disability in older adults. These two problems can lead to disabling forms of dementia and falls. Age-related cognitive and mobility impairments are clearly multifactorial, but with the rampant incidence of vascular disease in an aging population we cannot underestimate the role of cerebrovascular disease in age-related mobility disability and cognitive decline. Increasing evidence from epidemiological and clinico- pathological studies has established a strong link between vascular disease, particularly cerebral small vessel disease and the age related clinical outcomes of cognitive and mobility impairment. However, our current research and knowledge is based on surrogate radiographic measures of small vessel disease which are mostly irreversible. The overall goal of this study is to identify vascular measures of cerebral small vessels which precede the onset of cognitive and motor decline and are predictive of clinical and radiographic outcomes in small vessel disease. Such measures would allow us to identify individuals in the pre-clinical state when our prevention and therapeutic interventions could have a higher impact. Moreover, these measures can also be used in future clinical trials to monitor disease progression and to evaluate new therapies.